Ventilator-associated pneumonia related to extended-spectrum beta-lactamase producing Enterobacterales during severe acute respiratory syndrome coronavirus 2 infection: risk factors and prognosis.

Razazi, Keyvan; Luyt, Charles-Edouard; Voiriot, Guillaume; Rouzé, Anahita; Garnier, Marc; Ferré, Alexis; Camous, Laurent; Heming, Nicholas; Lapidus, Nathanaël; Charles-Nelson, Anais; Mekontso-Dessap, Armand; COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators

doi:10.1186/s13054-024-04906-2

Article (Scientific journals)

Ventilator-associated pneumonia related to extended-spectrum beta-lactamase producing Enterobacterales during severe acute respiratory syndrome coronavirus 2 infection: risk factors and prognosis.

Razazi, Keyvan; Luyt, Charles-Edouard; Voiriot, Guillaume et al.

2024 • In Critical Care, 28 (1), p. 131

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/328354

DOI
10.1186/s13054-024-04906-2

PubMed
38641851

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Keywords :

ARDS; COVID-19; ESBL; Nosocomial pneumonia; Ventilator-associated pneumonia; beta-Lactamases; Humans; Escherichia coli; Cohort Studies; Prospective Studies; Critical Illness; Intensive Care Units; Risk Factors; Klebsiella pneumoniae; Prognosis; Pneumonia, Ventilator-Associated; Critical Care and Intensive Care Medicine

Abstract :

[en] [en] BACKGROUND: Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring mechanical ventilation suffer from a high incidence of ventilator associated pneumonia (VAP), mainly related to Enterobacterales. Data regarding extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) VAP are scarce. We aimed to investigate risk factors and outcomes of ESBL-E related VAP among critically ill coronavirus infectious disease-19 (COVID-19) patients who developed Enterobacterales related VAP. PATIENTS AND METHODS: We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU) that included 4929 COVID-19 critically ill patients. For the present analysis, only patients with complete data regarding resistance status of the first episode of Enterobacterales related VAP (ESBL-E and/or carbapenem-resistant Enterobacterales, CRE) and outcome were included. RESULTS: We included 591 patients with Enterobacterales related VAP. The main causative species were Enterobacter sp (n = 224), E. coli (n = 111) and K. pneumoniae (n = 104). One hundred and fifteen patients (19%), developed a first ESBL-E related VAP, mostly related to Enterobacter sp (n = 40), K. pneumoniae (n = 36), and E. coli (n = 31). Eight patients (1%) developed CRE related VAP. In a multivariable analysis, African origin (North Africa or Sub-Saharan Africa) (OR 1.7 [1.07-2.71], p = 0.02), time between intubation and VAP (OR 1.06 [1.02-1.09], p = 0.002), PaO2/FiO2 ratio on the day of VAP (OR 0.997 [0.994-0.999], p = 0.04) and trimethoprim-sulfamethoxazole exposure (OR 3.77 [1.15-12.4], p = 0.03) were associated with ESBL-E related VAP. Weaning from mechanical ventilation and mortality did not significantly differ between ESBL-E and non ESBL-E VAP. CONCLUSION: ESBL-related VAP in COVID-19 critically-ill patients was not infrequent. Several risk factors were identified, among which some are modifiable and deserve further investigation. There was no impact of resistance of the first Enterobacterales related episode of VAP on outcome.

Disciplines :

Anesthesia & intensive care

Author, co-author :

Razazi, Keyvan; Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010, Créteil, France. keyvan.razazi@aphp.fr ; IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil (UPEC), 94010, Créteil, France. keyvan.razazi@aphp.fr ; Service de Medicine Intensive Réanimation, CHU Henri Mondor, 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France. keyvan.razazi@aphp.fr

Luyt, Charles-Edouard; Service de Médecine Intensive Réanimation, Institut de Cardiologie, Sorbonne-Université, Hôpital Pitié-Salpêtrière, and Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), 47-83, Boulevard de L'Hôpital, 75651, Paris, France

Voiriot, Guillaume; Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France

Rouzé, Anahita; Inserm U1285, CHU Lille, Service de Médecine Intensive - Réanimation, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, 59000, Lille, France

Garnier, Marc; GRC29, DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, Paris, France

Ferré, Alexis; Intensive Care Unit, Versailles Hospital, Le Chesnay, France

Camous, Laurent; Medical and Surgical Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Les Abymes, France

Heming, Nicholas; Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin - University Paris Saclay, Paris, France ; Laboratory of Infection and Inflammation - U1173, School of Medicine Simone Veil, INSERM, University Versailles Saint Quentin - University Paris Saclay, Garches, France ; FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), Garches, France

Lapidus, Nathanaël; INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, Sorbonne University, 75012, Paris, France

Charles-Nelson, Anais; Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, INSERM, Centre d'Investigation Clinique1418, Module Épidémiologie Clinique, AP-HP (Assistance Publique Hôpitaux de Paris), Paris, France

Mekontso-Dessap, Armand; Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010, Créteil, France ; IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil (UPEC), 94010, Créteil, France ; INSERM, Unité U955, Université Paris Est, 94010, Créteil, France

COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators

Other collaborator :

Lambermont, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs

Language :

English

Title :

Ventilator-associated pneumonia related to extended-spectrum beta-lactamase producing Enterobacterales during severe acute respiratory syndrome coronavirus 2 infection: risk factors and prognosis.

Publication date :

20 April 2024

Journal title :

Critical Care

ISSN :

1364-8535

eISSN :

1466-609X

Publisher :

BioMed Central Ltd, England

Volume :

Issue :

Pages :

131

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://link.springer.com/content/pdf/10.1186/s13054-024-04906-2.pdf

Funding text :

This study was funded by the Fondation APHP and its donators through the program \u00AB Alliance Tous Unis Contre le Virus\u201D, the Direction de la Recherche Clinique et du D\u00E9veloppement, and the French Ministry of Health and the foundation of the University hospitals of Geneva, Geneva, Switzerland. The funder had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This study was funded by Minist\u00E8re des Affaires Sociales, de la Sant\u00E9 et des Droits des Femmes.

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